Recent Submissions

  • A comparison of postoperative pain between DIEP and extended latissimus dorsi flaps in breast reconstruction

    Misra, Alok; Chester, Darren; Park, Alan; Misra, Alok; Plastic and Reconstructive Surgery; Medical and Dental; George Eliot Hospital (Lippincott, Williams & Wilkins, 2006-04)
    Background: The senior author (A.P.) has performed 70 consecutive breast reconstructions over 3 years using the free deep inferior epigastric perforator (DIEP) and pedicled extended latissimus dorsi flaps. This study set out to compare these two methods of reconstruction by looking at postoperative morphine requirements and lengths of stay in hospital. Methods: Patient notes were retrospectively reviewed and the total morphine used by patient-controlled analgesia was measured. Results: The mean morphine per kilogram required by patients who had DIEP flaps (0.21 mg/kg; n = 22) was significantly less than the amount required by patients who had extended latissimus dorsi flaps (0.47 mg/kg; n = 48; p < 0.001). An observed trend also revealed that DIEP flap patients remained in hospital for less time compared with extended latissimus dorsi flap patients, although the difference was not significant (p > 0.01). Conclusions: This study shows that DIEP flap patients require less postoperative morphine and therefore might experience less pain than extended latissimus dorsi flap patients. DIEP flap patients may also leave the hospital sooner.
  • Experience with the modified hockey stick incision for block dissection of neck

    Dancey, A. L.; Srivastava, S.; Srivastava, S.; Dancey, A. L.; Plastic Surgery; Medical and Dental; George Eliot Hospital (Elsevier, 2006)
    Background: The modified hockey stick incision was originally described by Lahey in 1940. This allows elevation of a superiorly based cervical skin flap, with additional exposure of the parotid as necessary. Methods: The longitudinal portion of the incision runs from the mastoid process downward, behind the anterior border of the trapezius muscle, and curves gently at the junction of the lateral one-third and medial two-thirds of the clavicle. The transverse component extends medially, approximately 2 cm below the clavicle. When parotidectomy is required, incision is extended in front of the ear and a forward cut is made for additional exposure. Results: We present our experience with a series of 16 patients, undergoing a total of 17 neck dissections for various pathologies. The majority (11 patients) received postoperative radiotherapy. There were two episodes of minor skin necrosis which were not related to radiotherapy, but to patient co-morbidity, and settled with conservative management. All patients had a satisfactory cosmetic result. Conclusion: We find the modified hockey stick incision to be cosmetically superior and provide excellent exposure of the neck, with protection of the carotid vessels.
  • Implantable contraceptive devices: primum non nocere

    Bragg, Thomas W. H.; Jose, Rajive M.; Bland, John W.; Matthews, Richard N.; Srivastava, Shekhar; Bragg, Thomas W. H.; Jose, Rajive M.; Bland, John W.; Matthews, Richard N.; Srivastava, Shekhar; et al. (PMH Publications, 2006-07)
    No abstract available
  • Late erythema after photodynamic therapy to the face

    Misra, Alok; Maybury, Karen; Eltigani, Tigani A.; Eltigani, Tigani A.; Plastic Surgery; Medical and Dental; Department of Plastic and Reconstructive Surgery, George Eliot Hospital, Nuneaton, Warwickshire, United Kingdom. (Lippincott, Williams & Wilkins, 2006-06)
    No abstract available
  • The patient's experience of a nurse-led nipple tattoo service : a successful program in Warwickshire

    Clarkson, James H. W.; Tracey, Annette; Eltigani, Eltigani; Park, Alan; Clarkson, James H. W.; Tracey, Annette; Eltigani, Eltigani; Park, Alan; Breast Care; Plastic Surgery; et al. (Elsevier, 2006)
    Introduction and aims: Although once the preserve of tattoo artists, units within the UK have increasingly begun making use of the Clinical Nurse Specialist (CNS) to perform areola tattooing. Bringing the technique within the Breast Unit enhances continuity of care and makes use of skills that can be provided by the CNS. Our CNS is involved with both the patients' oncological management and the areola tattoo service. Materials and methods: The CNS-led service was investigated and patients' experiences of nipple tattooing were assessed. We present the results of a postal questionnaire and a prospective clinical audit of the procedure. Results: Forty tattoos were done over a 2-year period with one self-limiting complication. Patient satisfaction was high both with the outcome and the experience of the procedure. Fading of the tattoo is a consistent finding frequently requiring further shading. Conclusion: Overall the patient's experience of a nurse lead 'in-house' tattoo service has been highly satisfactory and this is reflected by their high confidence rating and ease of access to the nurse. We believe that the role of the CNS in oncological treatment and reconstructions helps integrate the multidisciplinary experience for the patient.
  • Ulnar nerve compression in Guyon's canal in the presence of a tortuous ulnar artery

    Jose, R. M.; Bragg, T.; Srivastava, S.; Jose, R. M.; Bragg, T.; Srivastava, S.; Plastic Surgery; Medical and Dental; George Eliot Hospital (Churchill Livingstone, 2006-04)
    A case of ulnar nerve compression in Guyon's canal occurring in the presence of a tortuous ulnar artery in the canal is presented and the pathology and classification of ulnar nerve compression in Guyon's canal discussed.
  • Centralisation of a hypospadias repair service--the Warwickshire experience

    Hardwicke, J; Clarkson, J; Park, A; Hardwicke, J.; Clarkson, J.; Park, A.; Plastic Surgery; Medical and Dental; George Eliot Hospital NHS Trust (Elsevier, 2007)
    An audit of the hypospadias repair service provided in the county of Warwickshire has shown that centralising all referrals to a single surgeon who uses limited, well-practiced techniques, greatly improves outcome. Comparison to previous audit of the service, when provided by a number of surgeons in the region, shows complication rates dropping - fistulae occurrence reducing from 35.8% to 6.7% and urethral stricture rates showing similar improvement from 4.4% to 0%. Overall productivity increased, and referral out of region dropped from 13% to 0%. This provides definitive evidence that restructuring of a service already in place has decreased morbidity and increased efficiency to give results comparable to published data.